直肠癌切除术后回肠袢式造口术的结局：来自意大利多学科造口研究组（MISSTO）的一项前瞻性观察性多中心横断面研究。
Outcomes of loop ileostomy after rectal resection for cancer: A prospective observational multicenter snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO).
作者信息
Ferrara F, Rizzo G, Bondurri A, Forni C, Anania G, Anastasi A, Baiocchi G L, Boccia L, Cassini D, Catarci M, Cestaro G, Cillara N, Cobellis F, De Luca R, De Nardi P, Deidda S, Delogu D, Fedi M, Giuffrida M C, Grossi U, Impellizzeri H, Langone A, Lauretta A, Lo Celso F, Maffioli A, Manigrasso M, Marafante C, Marano L, Marinello P, Massucco P, Merlini D, Morelli L, Mozzon M, Pafundi D P, Pata F, Pellino G, Peltrini R, Petrina A, Piazza D, Rabuini C, Resendiz A, Salmaso B, Santarelli M, Sena G, Siragusa L, Tamini N, Tondolo V, Tutino R, Vannelli A, Veltri M, Vincenti L, Parini D
机构信息
Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), Unit of General and Oncologic Surgery, "Paolo Giaccone" Hospital, University of Palermo, Via Alfonso Giordano, 90127, Palermo, Italy.
Unit of Digestive and Colorectal Surgery, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy.
出版信息
Tech Coloproctol. 2024 Dec 11;29(1):16. doi: 10.1007/s10151-024-03047-6.
BACKGROUND
Diverting ileostomy is a common procedure in rectal cancer surgery, but it is sometimes associated with a nonnegligible rate of complications. The primary aim of this study was to analyze the incidence and types of stoma-related complications for ileostomy creation after rectal cancer resection. The secondary aims were to report the indications, the technical details, and the efficacy of stoma care provided by ostomy nurses.
METHODS
From 15 February to 31 December 2022, consecutive patients who underwent protective ileostomy after anterior rectal cancer resection were enrolled for prospective data collection at 45 Italian colorectal surgery centers. Univariate and multivariate analyses were performed to evaluate factors that influenced the occurrence of stoma-related complications.
RESULTS
In all, 287 patients were enrolled in the analysis. The short- and long-term postoperative stoma-related morbidity rates were 33.8% and 29.62%, respectively. The most frequent complications were dehydration (17.77%), peristomal skin dermatitis (13.59%), mucocutaneous separation (8.36%), and stoma retraction (4.18%). At the end of follow-up (median time 9 months), the overall stoma closure rate was 83.97% (241 patients), with a median time to stoma closure of 146 days (range 9-483 days). On multivariate analysis, the presence of a stoma nurse was a significant protective factor against stoma-related complications.
CONCLUSIONS
This study demonstrated that the creation of a protective ileostomy is associated to a nonnegligible rate of short-term and long-term postoperative stoma-related morbidity, higher than 25%. The most frequent complication is dehydration, and the presence of stoma-specialized nurses seems to be a protective factor for stoma-related complications. Moreover, more than 15% of protective stomas were not closed at the end of follow-up.
背景
回肠造口转流术是直肠癌手术中的常见操作，但有时会伴有不可忽视的并发症发生率。本研究的主要目的是分析直肠癌切除术后回肠造口相关并发症的发生率和类型。次要目的是报告造口的适应证、技术细节以及造口护士提供的造口护理效果。
方法
2022年2月15日至12月31日，意大利45个结直肠手术中心对直肠癌前切除术后行保护性回肠造口术的连续患者进行前瞻性数据收集。进行单因素和多因素分析以评估影响造口相关并发症发生的因素。
结果
共有287例患者纳入分析。术后短期和长期造口相关发病率分别为33.8%和29.62%。最常见的并发症是脱水（17.77%）、造口周围皮肤皮炎（13.59%）、黏膜皮肤分离（8.36%）和造口回缩（4.18%）。随访结束时（中位时间9个月），总体造口关闭率为83.97%（241例患者），造口关闭的中位时间为146天（范围9 - 483天）。多因素分析显示，有造口护士是预防造口相关并发症的显著保护因素。
结论
本研究表明，保护性回肠造口术与术后短期和长期造口相关发病率高于25%这一不可忽视的发生率相关。最常见的并发症是脱水，造口专科护士的存在似乎是造口相关并发症的保护因素。此外，随访结束时超过15%的保护性造口未关闭。
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